LA County gets $321 million to treat homeless who appear in CARE Court

When a homeless person impacted by mental illness or substance abuse is brought before a CARE Court judge in Los Angeles County later this year, the new Community Assistance, Recovery and Empowerment program aims to send the homeless person to a treatment facility.

It is hoped that the state-ordered program starting Dec. 1 at the Los Angeles County Superior Court in Norwalk will provide life-saving help to those in need, such as unhoused individuals on the schizophrenia spectrum, or those addicted to the highly dangerous drug, fentanyl.

But there’s one problem: CARE Courts won’t work without enough beds and behavioral staff to provide the care, the weakest link in ramping up the program later this year.

Last week, the county received $321 million in state funding for the next four years to build and staff residential treatment homes for those ordered into treatment by a judge, creating a wave of optimism from elected county officials and public health administrators who are up against a tight deadline.

“We will be able to provide 1,600 mental health and substance abuse beds,” said Fourth District County Supervisor Janice Hahn. “This is so critical and one of the most pressing needs for people without homes.”

Called “bridge housing,” the facilities will provide residential care for several months or up to a year. Some will get medication and others will get treatment for mental illness, while others may be placed in sober housing to ensure sobriety. But no individuals will be forced to take their medications.

Starting in December, behavioral health providers, emergency responders and family members can petition a judge in the county’s CARE Court to hear the case of an individual impacted by mental illness. The judge will come up with a treatment plan for that person, which may include housing resources and/or substance-use treatment and mental health care. The county is then required to provide that help.

It won’t be an easy task to provide bridge housing and the behavioral specialists needed to treat CARE Court defendants.

“We are already looking at a huge shortage in the number of psychiatric beds needed,” said Sarah Hunter, senior behavioral scientist and director of the RAND Center on Housing and Homelessness in Los Angeles.

A report released by the RAND Corp. entitled “Adult Psychiatric Bed Capacity, Need, and Shortage Estimates in California — 2021“ found that the state has a shortfall of 4,767 acute-level and sub-acute level care beds, not counting state hospital beds.

A RAND survey of homeless individuals in L.A. County estimated that 57% have a mental health issue and 21% have a substance abuse issue, Hunter said.

The county’s homeless population in 2023 grew by 9% from 2022, amounting to a total of 75,518 people homeless on any night in L.A. County, according to the point-in-time count conducted Jan. 24 through Jan. 26.

“As we come closer to the launch of CARE Courts on Dec. 1, we are being careful to have enough mental health housing,” Supervisor Hahn said.

It’s clear that the CARE Courts can only be effective with adequate resources, something that remains to be seen, Hunter said.

“How are they going to use this money? How are they going to ensure quality? How will they roll all this out?” Hunter said are some of the questions to be answered between now and Dec. 1. “So, the devil is in the details in implementation — on how the county operates these programs.”

The county is busy negotiating and executing contracts for bridge housing programs and services with the state’s third party, the Advocates for Human Potential (AHP). Then the county will most likely turn to familiar nonprofit organizations they’ve been doing business with that provide similar care.

Some existing programs divert inmates from county jails who the court decides would be better off in a substance abuse prevention or mental health treatment facility. Hunter said the county will rely on services that divert clients from the criminal justice system and into community living.

“Now, they will be diverting people who are homeless and mentally ill,” Hunter said. “This is different.”

Hahn said the county surveyed nonprofit providers and got a big response for more beds than the county has the money to fund.

Often, nonprofits providing services — and even county employees — are working on “shoestring budgets” and deserve higher repayment rates in order to ensure high quality service, Hunter said.

“We would like you to make sure my coworkers be paid equitably,” Julia Wallace told the board of supervisors on Tuesday, July 11. She identified herself as an employee of the county’s Department of Mental Health.

Bridge housing won’t be built from scratch but will be created by repurposing buildings, said Lisa Wong, director of the county’s Department of Mental Health during the board meeting. “Largely we will be repurposing, with renovations, because of the short time frame,” she added.

About $56 million will be used to purchase and repurpose buildings for bridge housing in the Skid Row area, where many of the unhoused live, said First District Supervisor Hilda Solis. “We want to purchase some buildings there and repurpose them. One will start at the end of this year. That is pretty quick,” Solis said.

Barbara Ferrer, executive director of the county’s Department of Public Health, explained at the board meeting that her department will use about $62 million for two kinds of bridge housing. Recovery Bridge Housing provides further treatment as well as room and board, for clients who come out of outpatient treatment. Second, Recovery Housing beds will be available for homeless to get off drugs and alcohol — what Ferrer called “people on a sobriety journey who need a place to live.”

Fifth District Supervisor Kathryn Barger compared the new sobriety houses to former “board and care” or “group homes,” many of which have been closed. However, she said she wants to make sure the new facilities are spread throughout the county, because in the past they were concentrated in Altadena and the Antelope Valley.

Wong said the DMH will follow the county’s equity plan, spacing future bridge home facilities throughout the 10 million population county. However, she said bridge housing for treating psychological illnesses and substance abuse should be near areas where the homeless reside.

“People are much more willing to stay in housing if it is in their community,” Wong said.

Second District Supervisor Holly Mitchell said the county must continue to fund the bridge housing sites, and not let them shut down in the future. “What will be our plan to sustain these beds beyond this one-time funding opportunity?” she asked at the meeting.

Wong responded, saying the county hopes to receive additional funding from the state once the first round of funding is spent. “We want to keep this going and maybe even add to it,” Wong said.